From the Guidelines
Calf pain that worsens at rest and improves with activity is not a symptom of intermittent claudication.
Characteristics of Intermittent Claudication
- Intermittent claudication is characterized by reproducible discomfort or fatigue in the muscles of the lower extremity that occurs with exertion and is relieved within 10 minutes of rest 1.
- The classic symptom of peripheral artery disease (PAD) is claudication, which is cramping, aching, or pain in the calves, thighs, or buttocks that occurs with walking 1.
Differential Diagnosis
- Several conditions can cause leg pain that may be mistaken for intermittent claudication, including:
- Hip arthritis: aching discomfort that is improved when not bearing weight 1
- Foot/ankle arthritis: aching pain that may be present at rest and improved by not bearing weight 1
- Nerve root compression: sharp lancinating pain that is induced by sitting, standing, or walking and often present at rest 1
- Spinal stenosis: pain and weakness that may mimic claudication and is relieved by lumbar spine flexion 1
- Venous claudication: tight, bursting pain that occurs after walking and subsides slowly 1
- Chronic compartment syndrome: tight, bursting pain that occurs after strenuous exercise and subsides very slowly 1
Key Points
- A thorough vascular examination with a focus on the lower extremities is necessary to diagnose PAD 1.
- The presence of all 4 (right and left) posterior tibial and dorsalis pedis pulses on palpation is associated with a low likelihood of PAD 1.
- Exercise therapy is an effective treatment for patients with PAD, improving functioning and quality of life 1.
From the Research
Definition of Intermittent Claudication
- Intermittent claudication is defined as leg muscle pain, cramping, and fatigue brought on by ambulation/exercise, relieved on rest, and caused by inadequate blood supply 2.
- It is the primary symptom of peripheral arterial disease (PAD) and is associated with a low risk of limb loss long-term but is a significant marker of systemic cardiovascular risk 3.
Characteristics of Intermittent Claudication
- The pain typically occurs in the calf, but can also occur in the buttock, thigh, or foot 4.
- The pain is usually characterized by leg pain, aches, cramps, or fatigue when walking, which improves with rest 5.
- Intermittent claudication does not begin at rest and resolves within 10 minutes of rest 4.
Calf Pain that Worsens at Rest and Improves with Activity
- The provided studies do not describe calf pain that worsens at rest and improves with activity as a symptom of intermittent claudication.
- In fact, the studies suggest that intermittent claudication is characterized by pain that occurs during activity and improves with rest, not the other way around 4, 5, 2, 3.
- Therefore, calf pain that worsens at rest and improves with activity is not a typical symptom of intermittent claudication.
Treatment and Management of Intermittent Claudication
- Exercise therapy, including supervised exercise programs, is often recommended as the first treatment for intermittent claudication 5, 2, 6.
- Pharmacological treatments, such as statins and antiplatelet therapy, may also be used to manage intermittent claudication and reduce the risk of cardiovascular events 4, 2.